Rethinking Trauma: George Bonanno on Resilience

“Bad things happen.” That’s the way that George Bonanno often begins his presentations on trauma and resilience. And bad things do indeed happen, from individual tragedies like the death of a loved one, loss of a job, or a serious illness to major disasters like the bombing of the World Trade Center or the recent earthquakes in Haiti and Chile. What happens to people after traumatic events and why? We were treated to fascinating answers to these questions during his visit to Cornell this week.

I’ve always been personally intrigued by why responses to difficult life events are so dramatically different. I think it’s because of what I would call “A Tale of Two Grandmothers.” My maternal and paternal grandmothers were roughly the same age, and both had been through tragic life events when they were younger. “Nan” and “Grandma” had both lost much of everything they had during the Great Depression, and both of their husbands died young, leaving them widowed and alone. But my mother’s mother, Nan, thrived despite loss. She lived healthily and happily to age 93, helping my own widowed mother to raise my three brothers and me. Grandma, on the other hand, was emotionally disturbed by her losses, unable to shake pervasive grief and loneliness, often repelling the people who tried to help her.

When George Bonanno, a professor of clinical psychology at Columbia University, began working in the field of bereavement, many people working in the field either believed in fixed stages of grieving (such as those popularized by Elisabeth Kübler-Ross) or that people must always express and work through grief. In contrast, his research has identified resilience as the core experience of most people who experience trauma. By resilience is meant the ability of individuals exposed to a potentially highly disruptive event to maintain both healthy psychological and physical functioning and the capacity for positive emotions.

All of us have known people like that, and it turns out they are in the majority. Applying rigorous research methods to trauma and grief, George found that many people recover well on their own. Further, in such cases, offering treatment to people who don’t need it can actually cause them harm, leading to the kinds of symptoms grief counseling is supposed to prevent.

In an interview about what such people should do after a trauma, George noted:

People who are not showing grief symptoms, don’t do anything — they’re fine. In fact, they can be harmed by intruding on their lives. They don’t need to talk about it, but I think in this culture we have this sense that people need to talk about it — if they don’t talk about it, something is wrong — no, leave those people alone. In people who are showing moderate levels of grief symptoms, it is sometimes a matter of getting used to the pain, which passes with time.

George has courted some controversy with his research, because professional counselors find it hard to believe that people do not need treatment of some kind after a tragic loss. But his astonishing array of studies – ranging from people who experience the 9/11 terrorist attack, to Hong Kong residents affected by the SARS epidemic, to people living under chronic stress in the Palestinian territories – show that of all reactions to trauma, resilience is the most common.

Rather than focusing on the pathologies that are supposed to follow trauma, George’s research points us toward looking at how to promote resilience and positive emotion after loss. One way, interestingly, is smiling and laughter (and George himself laced his talk with humor, despite the difficult topic). Although people who can smile and even laugh shouldn’t be accused of not grieving enough – George’s research shows that laughter almost always has a positive effect.

In sum – good news for us all, since every one of us will experience loss at some point. George’s work points toward strengh-based approaches to coping with traumatic events, and demonstrates the human capacity for resilience most humans share. I highly recommend George’s recently published book, The Other Side of Sadness: What the New Science of Bereavement Tells Us About Life After Loss.Written for a general audience, it’s a model of research translation on these issues.

Comments

In response to Kathy’s comment, below, I said I would consult a wise colleague. I asked Cornell Prof. Elaine Wethington, one of the country’s leading experts on stress and coping. Here’s what she had to say:

“This typifies reliance on an emotion-management coping style that has proven successful in the past in managing negative emotions. Some researchers have labeled this strategy “denial”, which is a pretty negative label, while others have given it a more neutral name, “emotion management.” A few researchers have studied whether coping, to be successful, should maximize flexible responses to changing environments over time. George Bonanno himself does this. Overall the literature suggests that the most successful coping style over time is one that includes many types of coping, including thinking through how to manage negative emotions in more proactive ways. I think it is a difficult question whether exploring negative memories is the best course for someone who has unhappy memories of childhood and has developed an adaptive style that controls these memories and makes daily life more pleasant. “

A very interesting perspective! I’ve also known people who had both reactions to loss/trauma, and the people who acted more ‘resilient’ did indeed seem happier later on. My grandmother was crippled by the loss of my grandfather, while my aunt has found happiness despite having lost her first husband years ago.
I do wonder, though, about the response of a friend of mine to her traumatic childhood: While claiming to be one of the happiest people she knows, and feeling no need to discuss her problems with anyone else, she also prefers to distract herself rather than dealing with her problems, and often falls behind in her job and studies. She also believes that no-one will ever care about her much; she says she is content with this idea, because it frees her from social obligations.
Is my friend’s reaction a particularly successful example of resilience — after all, she doesn’t let her problems bother her and she does appear to be generally happy — or would she benefit from psychological exploration? I know this isn’t Dear Abby, but it’s an interesting question about the relative value of exploring negative emotion(s). I guess I’ll have to read the book!

I wish we were Dear Abby! But alas, you are right that clinical advice would get us sued for impersonation, probably. That said, my reading of George’s work is that the need for additional help depends greatly on the subjective level of distress experienced by the person. The case you describe sounds complicated, because on the one hand others can observe what seems to be unsuccessful coping (having such low expectations) but the individual says she feels fine.” It sounds like in a case like that, the person might benefit from counseling, but not necessarily because of the trauma.

I’ve asked a knowledgeable colleague for her comments, and we can see what she says.

My father died when I was 5 1/2., I tend to be a cheerful, optimistic person, as was my mother. However, I recognize that ;probably as a result of this loss I resist being dependent on others and don’t feel love or grief as others do. I don’t know if this emotional detachment could have been alleviated if I had had counselling after my father’s death.

This is an excellent point, and one I think George Bonanno highlights. Counseling doesn’t need to be provided for everybody, but for some people it is a key to successful coping. I certainly know a lot of people who have benefited from counseling after loss.

The research on this issue isn’t totally consistent. Some studies find that the death of a parent in childhood can lead to problems later on, but other studies have found no effects on adults (at least in terms of mental health measures like depression). An interesting article came out recently that did find a strong effect of the father’s death in childhood on adult depression. But the main reason was the financial strain that caused on families, often lasting for years. The article is:

John R. Gacobs and Gregory B. Bowasso. Re-Examining the Long-Term Effects of Experiencing Parental Death in Childhood on Adult Psychopathology. The Journal of Nervous and Mental Disease, volume j197, Issue 1, January 2009. Pp. 24-27.

I think the format for your blog is great! This is the first time I looked at it. Has Bonnano looked at what besides positive emotions help in recovery from trauma? I am particularly interested in how people use nature for personal resilience/restoration. I am familiar with the literature from the environmental psychology point of view, but have not seen the mainstream psychologists address this issue. Thanks Karl and Rhoda! Marianne

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